Provider Demographics
NPI:1225184641
Name:TANNER, RICHARD ROSS (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ROSS
Last Name:TANNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2648 CONCORD BLVD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94519-2605
Mailing Address - Country:US
Mailing Address - Phone:925-686-3260
Mailing Address - Fax:
Practice Address - Street 1:2648 CONCORD BLVD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94519-2605
Practice Address - Country:US
Practice Address - Phone:925-686-3260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice